SSCSiP’s Stakeholders Reference Group (SRG) Meeting

The SSCSIPs SRG (Stakeholder Reference Group) was held on the 24th and 25th of April, 2016 in Suva which was held just before the SPC Heads of Health meeting (26th and 27th of April) at the same venue.

The theme of this year’s meeting was Specialized Clinical Services (SCS) in Totality; The Way forward included topics such as: the FNU and RACS contribution to SCS, Regional Initiatives, Natural disasters and the role of SCS during disasters, Biomedical, Nursing Specialization, the contribution of Pacific Clinical Organisations and Development Partners and the Way Forward.

The keynote speaker, the President of the Royal Australasian College of Surgeons (RACS) Professor Watters reported on the meeting of the World Health Assembly 68/15 which extended Universal Health Coverage to include Strengthening Emergency and Essential Surgical Care; directing a new focus on surgical services as an integral part of health care. The Assembly declared that “universal access to safe, affordable surgical and anaesthetic care when needed” was a global priority.

The Lancet Commission on Global Surgery 2030, evidence and solution for achieving health, welfare and economic development published on April 27, 2015, highlighted the extent of the large shortfall in surgical responses compared to the large need – 5 billion people without access to safe affordable surgical and anaesthesia care when needed – and that 143 million additional procedures are needed each year in low and middle income countries (LMIC).

The Lancet Commission identified 3 procedures that were indicative of surgical capacity – that if these 3 procedures could be done safely, many other procedures on the list of surgical procedures could also be done safely. These are titled the ‘Bellwether Procedures’ and include Caesarean Deliveries, Laparotomy and the treatment of Open Fractures.

The Commission identified a target staffing level of 20-40 Surgeons, Anaesthetists and Obstetricians providers per 100,000 population – and that the Pacific region is well below.

The economic benefits far outweigh the costs of in investing in surgery. Catastrophic expenditure results for ¼ of the 320 million operations globally p.a. 38% of global mortality is related to surgical need, and the increasing rates of Cancer and Injury are driving the increase. The Global Health Workforce is projected to have a shortfall of 18 million health workers by 2030. Investing in the workforce produces significant returns on investments. The plan is to increase the number of doctors by 25-40% in LMIC and LICs – which raises the question for the Pacific region – can the Pacific retain and sustain those it trains and avoid brain drain?

An important message for the Pacific Islands Countries is that an economic case can be made for increasing surgical investments. Investing in surgery is affordable, saves lives, and promotes economic growth. Financing surgical expansion in a way that decreases death and disability for patients, and maximizes economic benefits for countries, is both feasible and cost-effective.

Scaling up surgical and anaesthesia services to meet current population needs will require wide-scale financial investments in LMICs. If LMICs were to scale-up surgical services at an annual rate of 9% (a rate previously achieved by Mongolia, a high-performing country) to reach a surgical volume target of 5,000 procedures per 100,000 population, the total cost by 2030 would be approximately $420 billion. Although this financial cost of surgical expansion is significant, the cost of inaction on national incomes is much greater. The lost output (total GDP losses) will cost LMICs a total of $12.3 trillion dollars, reducing annual GDP growth as much as 2%.

Surgical care is affordable, saves lives, and promotes economic growth. Surgery is an indivisible, indispensable part of health care. It is essential that countries begin to measure and monitor surgical procedures and their outcomes in order to manage their health services (Compiled by Prof Graham Roberts).